Diabetes is often present for a number of years before it is diagnosed. During this time there is the potential for the progression of complications associated with diabetes. That is why it is so important that you immediately take action once you are diagnosed with diabetes. The best way to avoid or halt the progression of complications is to manage your blood sugars, blood pressure and blood cholesterol to the targets your diabetes doctor outlines for you.
Heart Disease and Stroke. The risk of developing coronary heart disease, which is the kind of heart disease that is commonest in western society and the kind that people with diabetes are particularly prone to, is very high. The risk is roughly double in diabetics when compared to the general population without diabetes. A large proportion of diabetics will present some form of arteriosclerosis, either in their heart in the form of angina, heart attack or congestive heart failure or in the circulation to the brain leading to stroke or in the circulation to the periphery leading to abnormalities of blood flow to the legs, the development of aneurisms in the abdomen and abnormalities of the blood flow to the kidneys.
The Eyes (Retinopathy). We know that about one in twenty Canadians have diabetes and even more than twice this number have it and just don’t know it. Years ago, a lot of patients used to lose eyesight from diabetes. It still happens but it happens a great deal less than it used to. The primary reason that it does not happen as much is because we are able to save a lot of patient’s eyesight by using laser treatment. Diabetes affects the blood circulation throughout the body including the small blood vessels everywhere and the eye is no exception. The eye is very much like a camera with lenses upfront and film in the back. The film that lines the back of the eye and takes pictures of what we see is called the retina. In the retina there are tiny blood vessels, arteries and veins that bring the blood to and from the back of the eye. In diabetes, the blood circulation is not as good as it ought to be and those blood vessels can close off and what can happen is new blood vessels can grow. They can cause bleeding and scarring and blood vessels can leak fluid into the center of vision, which is called the macula. The two problems that we see in diabetic eye disease are new blood vessels growing and bleeding and the blood vessels leaking fluid into the center. Both of those problems can be treated with laser, which can often cut vision loss in half. We find that if we catch patients early, while they still have pretty good vision, the laser treatment is much more effective. Therefore we really need to screen patients in advance before they have trouble with their eyesight on a routine basis, usually once a year. If they are doing well, we will see them back the next year. If they have problems, then we can do some tests to see whether laser treatment will be helpful in keeping their vision. Some of the people who take really good care of themselves can have wonderful sight for their whole lives and other people who are not as careful often lose significant eyesight.
The Kidneys (Nephopathy). In diabetes there is a very high risk for damage to the kidneys. As a result of high blood sugars and high blood pressure the small blood vessels in the kidney can become damaged and leaky. When this happens the filtering ability of the kidney is impaired and it is no longer as good at getting rid of the bad and keeping the good. One of the best ways to avoid kidney damage is to manage your blood sugars and blood pressure as best as you can. Your kidney function should also be checked by your diabetes doctor at least once a year.
The test is one that measures very small amounts of protein in your urine, and is called microalbumin. The test can be done on a urine specimen taken at any time of the day, or on one taken in the early morning. The results should be less than 2.8 mmols/mg of Creatinine in the female, and less than 2.0 in the male. Microalbumin, if present can be successfully treated by both good blood sugar control and good blood pressure control. The goal level of your blood pressure is less than 130 and less than 80 (130/80 mm Hg).
Nerve Damage (Neuropathy). In diabetes there can be progressive damage to the peripheral nerves, especially the feet and fingertips as well as the sexual organs. This can occur gradually so that many people are often unaware of the progression. One of best ways to avoid this is with good blood sugar and blood pressure management as well as regular physical activity. Nerve damage to the feet means that lesions or sores on the feet may go unnoticed and thereby become infected. The healing process is also not as rapid as it used to be. This is why you should check your feet everyday, the soles and in between the toes. Make sure any issues are dealt with.